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Premature closure of distal fibular growth plate: a case of longitudinal syndesmosis instability

  • Orthopaedic Surgery
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Abstract

Post-traumatic premature closure of distal fibular growth plate is a rare entity and results in shortened lateral malleolus. This can lead to lateral wedging of distal tibial epiphysis, valgus ankle and medial ankle instability. Ramsey and Hamilton noted experimentally that loss of fibular length caused a dramatic lateral shift in tibiotalar surfaces. Even a displacement of as little as 1 mm will distort the areas of tibiotalar contact and lead to early joint degeneration. Colton believed it is due to the oblique articular surface of the malleolus is no longer closely applied to the talus. We present a case of premature closure of distal fibular physis with lateral malleolar shortening. Ankle arthroscopy demonstrated syndesmosis instability resulted from shortened lateral malleolus and stability restored after fibular lengthening.

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References

  1. Austin RT (1987) Rotatory malunion of the lateral malleolus corrected by osteotomy. J Bone Joint Surg Br 69:481

    PubMed  CAS  Google Scholar 

  2. Beals RK, Skyhar M (1984) Growth and development of the tibia, fibula and ankle joint. Clin Ortho Relat Res 182:289–292

    Google Scholar 

  3. Berg EE (1994) Recurrent medial ankle instability: the result of distal fibular growth arrest. Foot Ankle Int 15:218–220

    PubMed  CAS  Google Scholar 

  4. Birch JC, Herring JA, Wenger DR (1984) Surgical anatomy of selected physes. J Paediatr Orthop 4:224–231

    CAS  Google Scholar 

  5. Candal-Couto JJ, Burrow D, Bromage S, Briggs PJ (2004) Instability of the tibio-fibular syndesmosis: have we been pulling in the wrong direction? Injury 35:814–818

    Article  PubMed  CAS  Google Scholar 

  6. Colton CL (1971) The treatment of Dupuytren’s fracture-dislocation of the ankle. J Bone Joint Surg Br 53:63–71

    PubMed  CAS  Google Scholar 

  7. Dias LS (1985) Valgus deformity of the ankle joint: pathologenesis of fibular shortening. J Paediatr Orthop 5:176–180

    CAS  Google Scholar 

  8. Frick SL, Shoemaker S, Mubarak SJ (2001) Altered fibular growth patterns after tibiofibular synostosis in children. J Bone Joint Surg Am 83:247–254

    PubMed  Google Scholar 

  9. Karrholm J, Hansson LI, Selvik G (1984) Changes in tibiofibular relationships due to growth disturbances after ankle fractures in children. J Bone Joint Surg Am 66:1198–1210

    PubMed  CAS  Google Scholar 

  10. Lalonde KA, Letts M (2005) Traumatic growth arrest of the distal tibia: a clinical and radiographic review. Can J Surg 48:143–147

    PubMed  Google Scholar 

  11. Lui TH, Ip KY, Chow HT (2005) Comparison of radiological diagnosis and arthroscopic diagnosis of distal tibiofibular syndesmosis disruption in acute ankle fracture. Arthroscopy 21:1370–1374

    PubMed  Google Scholar 

  12. Miller SD (1995) Late reconstruction after failed treatment for ankle fractures. Orthop Clin North Am 26:363–373

    PubMed  CAS  Google Scholar 

  13. Offierski CM, Graham JD, Hall JH, Harris WR, Schatzker JL (1982) Late revision of fibular malunion in ankle fractures. Clin Ortho Relat Res 171:145–9

    Google Scholar 

  14. Panchbhavi VK, Singh D, Trevino SG (2005) Clinical tip: Distraction technique for restoring length of the fibula in ankle fractures. Foot Ankle Int 26:501–502

    PubMed  Google Scholar 

  15. Ramsey PL, Hamilton W (1976) Changes in tibio-talar area of contact caused by lateral talar shifts. J Bone Joint Surg Am 58:356–357

    PubMed  CAS  Google Scholar 

  16. Roberts C, Sherman O, Bauer D, Lusskin R (1992) Ankle reconstruction for malunion by fibular osteotomy and lengthening with direct control of the distal fragment: a report of three cases and review of the literature. Foot Ankle 13:7–13

    PubMed  CAS  Google Scholar 

  17. Sharma OP, Sharma N, Patond KR (1994) Fibular shortening in poliomyelitis. Indian J Pediatr 61:71–74

    PubMed  CAS  Google Scholar 

  18. Ward AJ, Ackroyd CE, Baker AS (1990) Late lengthening of the fibula for malaligned ankle fractures. J Bone Joint Surg Br 72:714–717

    PubMed  CAS  Google Scholar 

  19. Weber BG (1981) Lengthening osteotomy of the fibula to correct a widened mortice of the ankle after fracture. Int Orthop (SICOT) 4:289–293

    CAS  Google Scholar 

  20. Weber BG, Simpson LA (1985) Corrective lengthening osteotomy of the fibula. CORR 199:61–67

    Google Scholar 

  21. Weber BG, Friederich NF, Muller W (1998) Lengthening osteotomy of the fibula for post-traumatic malunion. Int Orthop (SICOT) 22:149–152

    Article  CAS  Google Scholar 

  22. Yablon IG, Leach RE (1998) Reconstruction of malunited fractures of the lateral malleolus. J Bone Joint Surg Am 71:521–527

    Google Scholar 

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Lui, T.H., Chan, K.B. & Ngai, W.K. Premature closure of distal fibular growth plate: a case of longitudinal syndesmosis instability. Arch Orthop Trauma Surg 128, 45–48 (2008). https://doi.org/10.1007/s00402-007-0305-z

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  • DOI: https://doi.org/10.1007/s00402-007-0305-z

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